While health care and public health regularly generate powerful new innovations and interventions to improve patient outcomes and population health, they often fail to effectively and systematically spread better practice. Strategies for disseminating effective health programs (e.g., publishing, presenting, training) at the national- or international-level are insufficient to instigate and sustain behavior change at scale. As a result, patients and public do not benefit from interventions that can reduce suffering and lengthen their lives. In the last ten years, a small, growing group has increasingly expanded the study of how health care and public health can best introduce and scale-up better practices, but it has yet to comprehensively review its knowledge, catalogue the most effective approaches to change, identify current gaps in knowledge and establish an agenda for future research, policy and practice activity. As such, we propose a small conference that will seek to: review existing knowledge and current practices related to the scale-up and spread of effective practice in health care and public health;identify key challenges and gaps in research, policy and practice on scale-up and spread in health care and public health;develop and disseminate a detailed agenda outlining critical research, policy and practice initiatives on these topics for the next five to seven years;and launch specific activities to operationalize a plan of action to prioritize research, policy and practice activity and initiate powerful demonstrations of regional, national and international scale up in health care and public health. If successful, the meeting should yield durable guidance for researchers, practitioners and donors regarding strategies for spreading better practice and for furthering progress in improving spread, including blueprints for individual delivery systems, networks and policy bodies to more effectively spread effective practices across states and nations. Ultimately, it should stimulate the scale up of innovations in health care and public health to thousands of individuals and families - its output will be relevant across conditions, clinical settings and communities. We will achieve our aims by bringing together 100 experts representing US and non-US institutions in government, academia, and philanthropy and service delivery in Boston in late June 2010. This meeting, guided by a planning committee, will be modeled on the form of a Veterans Health Administration "state-of-the-art" (SOTA) conference, which will set five subcommittees to the work of answering key questions and developing a comprehensive agenda for the future. The meeting will require intensive preparation (e.g., commissioned papers, literature reviews, subcommittees, attendee pre-work) and will generate several important products (e.g., peer- reviewed papers, meeting proceedings, an agenda for future research and action for dissemination to government agencies, donors, health care delivery organizations, web-based communities) that will trigger action and effective spread of efficacious practice. PUBLIC HEALTH RELEVANCE: This meeting will generate knowledge and guidance applicable to diverse conditions, care settings and communities. Its fundamental goals are to develop a detailed catalogue insights and best practices in spreading effective interventions across diverse organizations and large populations (which should be broadly applied) and to build an agenda for research, policy and practice that will facilitate broader and more rapid scale-up and spread of sound practice in the future.